The diary of a triage nurse

I am a healthcare professional, an emergency triage nurse. In the following diary, I try to describe my experiences and feelings about this so far unknown, fearful epidemic. Don’t expect high literature, nor a professional paper. It is something else.

03.10.2020.

I had followed the news about coronavirus calmly, until the infection appeared in Italy as well.

It is a different culture, I calmed myself. Elderly people live active social lives there, they go out, socialise and often touch, kiss and hug each other. All the lovely and humane behaviour that I had so far missed from Hungarian mentality now appeared to be yet another opportunity to spread the infection. I felt frightened, anxious and excited at the same time. I watched the heroic struggle of the unknown Italian colleagues and wondered what if…? I couldn’t stop asking this, everybody discussed it at work too. Not like a gossip, but as a fear we share. Our supervisors informed us several times every day, showed us the protective gear that I had so far only seen on Insta or FB. We laughed, we wondered, but inside we all felt a very nervous anxiety.

We wait and hope that the cooler demeanour that Hungarians are accustomed to, and how we are only in close physical contact with those very close to us becomes a positive this time.

I am Ancsa, emergency triage nurse. I’m preparing for the task of fighting an unknown disease in the ER of a successful hospital. This anxious fear is a lousy feeling and I can only hope that it will bring the best out of us and me.

03.11.2020.

PANDEMIA

I have another night shift today. In the morning, during the bicycle ride home, I called my parents and my sister. I’m worried about them. I keep instructing them how to wash their hands, to stop using money, to use a credit card, and stay home. I’m tired but wound up.

I checked the news and the emails from my bosses. They contained precise instruction following those of the authorities. After a few hours of sleep I go online and watch the press conference of the operational group.

An emergency… The word that I live in, the one that has been a perfectly safe part of my life appears in a new role today. It’s the first time it makes me scared. I called my parents and sister. We chatted lightly, lovingly. They can sense my anxiety.

I went to work for the night. I started my shift and quickly got into the usual rhythm. I showed the patients waiting in the hall how to wash and disinfect their hands properly. They seemed to appreciate it.

It is a silent and warm spring evening outside. As I look at my phone, the first piece of news I see is PANDEMIA. The WHO announced it! They claimed this epidemic a pandemia at 10pm local time, 03.11.2020.

I had tears in my eyes, and felt like a part of history, just like the 7.5 billion other people. Our textbooks will come alive in the following period. My phone does not allow me to indulge in self-pity, worrying old friends, acquaintances call every few minutes. They are scared. So am I, but as I have no other option, I choose to consider this as a lesson from which I can learn a lot. Digital communication gives us a great advantage, so we have to use it to our advantage.

03.12. 2020.

After my shift, I spent some time with my colleagues. We listened to the news and talked. Last night, we got a load of emails again, detailing the regulations of precaution applying to us. It’s an abundance of information, hard to learn. There are hardly any patients at the ER, almost only drunken homelesses. It’s as if Budapest was empty. I haven’t seen a cystitis patient in days. It’s very scary. It’s like before a tsunami, when the sea recedes beforehand. Everyone is nervous, sometimes we snap at each other and bicker, but nothing serious, we know that we can only count on each other. It’s just to release the tension that has been winding us up for days.

After the morning chatter I biked home. I tried to sleep, but couldn’t, and gave up after 3 hours of slumber. My stomach hurts a bit, but it’s probably just the stress. I went shopping for some food. The meat shelves were almost empty at Tesco. A family bought up the last 10 kilos literally before my eyes. That’s fine, pasta is ok too, and sandwiches and sausages.

The ER is still completely empty. We got a tent to pretriage. (To assess the condition of the patients before entering the hospital. This is where the infected can be separated.)

We jumped a level. Nobody could rest properly, even though the whole department was empty. The silence is still scary.

03.13. 2020.

We become faceless people

90299594_200040757921792_771764881031430144_n

We talked a bit in the morning at shift change. Everyone circles around the tent getting to know the protective gear. Goggles, mask, overalls and gloves. This gear may save my life, but when I wear it, I won’t be Ancsa anymore. I will be one of the many faceless people, looking just like anyone else on duty. I slept 3 hours after great struggle. I even ate a few bites and drank a load of coffee. I answered some emails and talked to my family. I was numbly watching the press conference and fumbling with my phone when I got a message. “Have you heard?” “What?” “The quarantine!” What??? I went pale. My colleagues got quarantined for two weeks. I imagine quarantine like a prison for the goodies. Like a lesson of a sort. All I know is that you are not allowed to go outside or have contact with the outside world. Even its existence is hard to imagine until someone you know gets there.

03.14.2020.

 At work, I heard who had been quarantined. How could they have known the patient was corona positive? He had no typical symptoms. It’s such a sneaky virus, seriously! I hate it more and more… The management and the managing nurse persuaded the authorities that they would get quarantined here, at Uzsoki hospital. Home. That’s a bit of a relief. But this comfort was immediately gone as I saw the ambulance. The guy wore white overalls. Another faceless person. As the door opened, I saw people sitting, wearing medical masks. “Hi, Ancsa!”- I heard a familiar voice. I went closer and recognised my colleagues. I don’t wish this experience on anyone. I guess I arrived at the reality there, in that moment.

I am grateful to the FB and messenger, because it helps us to stay in contact with our locked up friends. We are also grateful to the management, they are like a candlelight in the dark.

03.15.2020.

Once again, in the morning I put off going home long. I talked to the guys, and we followed the news. Everyone is visibly tense. We are getting more and more nervous and the emails are getting more rigorous as well. They all have a weight and strength. I collect them, hate them but still read them. Sometimes I don’t even grasp the content. Like a student before finals, sitting in front of the door with a book on their lap mumbling in a no-input state. It feels dreadful. I talked to my family. I keep begging them to stay home. They promised and I believe them. They would never lie to me. I miss them.. My sister doesn’t let the kids to school either. They study at home and play. I don’t have to work tonight, but, of course, I cannot sleep. I talk to my family again, they are fine, and that finally calms me. It’s weird that they only live 10-20 km from me, it feels like a different continent. I am on call, like everyone else, so I can’t silence my phone. It keeps beeping constantly: email, sms, messenger, calls, it just can’t shut up. I learned that my colleagues have been transferred to home quarantine, meaning that they can wait at home, behind closed doors, patiently. That’s good… I guess it was the second best news this week. By 10pm I felt that I would be able to sleep.

03.16.2020.

I woke up at 5am. I checked the news, they gave me a stomach cramp. I have a headache too. I’m dehydrated. I had a tea and biked to the hospital. This trip was different from before. Something has changed. I could not tell what, but I can feel it deep inside.

There was a lot going on in the tent. The people waiting for their appointments at the gate just heard that according to a ministry decree, all appointments had been cancelled, and they were not allowed to enter. Some understood silently, some threatened that their death due to missing this appointment would be on me. A bunch of colleagues came from other departments. More and more wonder around the ER. It’s strange to see, as we were such a secluded world until now. Their care and help is touching. There are still very few patients coming. If an old patient with hypoxia arrives, we are startled. We explain to them why we are faceless and try to calm them. Everybody tries to help, they make all options available. We have protective gears which mean safety now. We can hardly eat. We are nervous… or exhausted, I don’t know.

It’s no better at home either, I’m all on edge and restless. I read my emails and see the press conference from yesterday. Cecilia Müller, the chief medical officer noted that the epidemic has jumped a level. We are no longer facing separate particular cases, but group infections the origins of which cannot be traced anymore. I guess I’m a bit scared. We are facing a savage virus that we know little of. Respiratory failure is a common case we are all familiar with as we have been in the field long enough. But we have never encountered it in a great number at the same time.

I don’t know what this misadventure is trying to teach us, but I believe that everyone needs to make sense of it for themselves so that we can move forward sensibly.

I’d better sleep now, in the morning everything starts again. I hope I’ll manage to sleep a few hours.

If possible, then please stay home. It’s not a request, it’s more like a plea. Every minute outside may increase the extent of this epidemic and the number of cases.

Stay home and hope with us!

 

03.17. 2020.

I CANNOT AFFORD TO STAY HOME- COVID TEAM

I woke up exhausted, I haven’t been able to sleep more than 3 hours for days, and that is not nearly enough. When I went to bed last night, I read through some emails, recommendations, orders of treatment. I don’t read news anymore, they freak me out. I got another email at night sometime between 1 and 2 am, the management sent the new orders of treatment. So they don’t sleep either… nobody does.

After the morning coffee and makeup (which is about as much use as a magic spell, it motivates inside, but quite ineffective outside), I hopped on my bike and went to work. It seemed like a Saturday morning in spring: the roads were all empty, so I got there quickly. I took over the shift, and we discussed the new order of treatment. All my colleagues look like panda bears with their pale faces and circles around the eyes. But the mood was good, we cracked jokes and teased each other. I could finally even eat a sandwich to my surprise, as I was not even hungry to begin with… But the smell of a good Gyulai sausage works wonders…

New people came to help again. Workers from the optometry department and from kindergartens helped us and secured the morning shift. The new development is the allocation plan after shift change. We discussed the daily action plan with the chief nurses. It was funny that the usually 5 minute long discussion now lasted 20 minutes, as one of our phones was always ringing. We appointed the COVID-TEAM. That was new, and a bit scary.

Then we assembled the whole shift together and explained to everyone their daily tasks, who would be responsible to which examining room. It was a bit like a field training exercise. These are necessary rounds. We constantly learn and strengthen ourselves inwardly. We checked the protective gear and the supplies, of which we have a safe amount. Sometimes I don’t even mind being in goggles and a mask all day, at least my tired face is hidden. Sometimes the chief appeared with some new info. We jokingly competed who slept less.

The hospital is still so empty you can almost hear the echo. It feels very odd. I suppose we have completely retreated to our own little universe. We didn’t even go to the café, despite that we like the food there, they have fresh schnitzel and buns. But somehow we did not feel like leaving our place. Maybe, because these days this is where we feel most at home. The chief physician asked one of his assistants to bake us a bundt cake. It was delicious, we almost forgot to breathe until we devoured it. The caring was very moving too. There are still very few patients in the ER, only really urgent cases come. That’s the most important result so far. There were also some interesting demands, but that didn’t surprise anybody.

90287326_205907410674559_588106873954107392_n

 

In the afternoon we played a team building game. I put on my suit, did my work, and then asked a colleague to help me take it off appropriately… well, it went fairly slowly. But that is extremely important! This bloody hot suit needs to be put on and taken off according to the manual! You cannot afford getting sick! You are needed!

At the end of our shift we just sat there in the changing room like bags of potatoes staring in front of us motionlessly. On the way home I called some buddies and friends who work in media communication. We try to organise everyone to help wherever they can. We all work in an amazing symbiosis. It was also nice to move out of the hospital environment mentally as well, even though we didn’t get very far, as the topic was still the effects of coronavirus, only from another perspective.

I’m exhausted now, I think I’ll be able to sleep properly. I need it badly, probably from Thursday on there will be loads to do. And that is only the beginning…

020.03.18

One of the most important things in an ER is to learn to take the increasing pressure

I got to bed at 1am. As soon as my head touched the pillow I fell asleep. I have dead annoying nightmares. Before I woke up I dreamt that I worked. I was in the ER at some meeting wearing protective overalls, and we were all yelling, because we couldn’t hear each other under the caps, but however we shouted, we couldn’t be heard because of the masks. Then I heard the sound of the tetra (the radio emergency units use to call us before they arrive with a patient). I jumped up and tried to struggle through the crowd. The phone woke me up, a colleague inquired about a patient from yesterday, but I interrupted her screaming “what day is it??” She didn’t know either. We burst out laughing.

I managed to go shopping and to the cosmetologist. I swear I felt as if I was a princess for a whole hour. In the supermarket the shopkeepers looked exhausted and chased. They spread the products at an amazing speed, while the customers stacked everything up in their carts without thinking. Human weakness could really surprise me sometimes. An old lady, who is otherwise probably really cute, bought up all the detergents from the shelves. I’ll never get the logic in that. Is perhaps washing clothes her mania?

Today I looked through my online stuff and the new FB. It’s a bit weird, but I think it will be very cool. I was a lot calmer today. I didn’t read the news. This quiet calm lasted until the afternoon. I shouldn’t read news until July.

In the evening, I packed my stuff for tomorrow. As I packed, my pulse kept increasing. I cannot stop being stressed. Seriously, when this whole mess is over I’ll have withdrawal symptoms. I keep training myself, and often think of my boss from the time when I was still a beginner. One day, after a tough shift he called me in his room, and told me “Ancsa, one of the most important things in an ER is to learn to take the increasing pressure. Accept that the pressure may grow from hour to hour while a situation may worsen practically minute by minute. Tonight I’ll go to sleep with this thought. And that I’m not alone. The whole staff of the ER and the hospital are now my closest colleagues.

  

03.19. 2020.

When the hospital being your second home is not just a joke

I finally managed to get 8 hours of sleep. I really needed that. I tumbled out into the kitchen and saw my writing on the fridge: “This is your day! It’s the award gala of the Anna Richter prize” with a to do list under: 9 o’clock, hairdresser, 11: cosmetologist then manicure. Arrival at the scene at 15. I stared at the list and felt sad. It could have been a defining day of my life. Instead fate gave me a defining month, or two, maybe three in the worst case. Everything changed within days. The past days seem like they were years ago with all their events and details, and the only thing left is the present and the near future. The 12 hours project is now waiting in a corner of my heart waiting until I fight coronavirus with my colleagues. I have to accept and incorporate this into my life now.

I could not spend much time with self-pity, because my phone warned me that I slept through 18 emails and about 3 dozens of messages. I turned on the computers and started doing my media work. That is what holds my head above water nowadays, by blog and the media work that gives me strength and momentum, to take this depressing madness with a sane mind. I read all the letters and messages. I managed to send the requested material to the advisory board 2 days after the deadline and upload the important infographics that advise people.

In the meantime informing letters keep coming from the hospital, and these have a priority now in all respect. The collegiality that joins the workers in the Uzsoki hospital now is really moving. As the situation may change hour from hour, the strategy must also adjust to the changes. We all live in and are shaped by a magical symbiosis. We are one team. We are taken care of in all possible ways, and that is so important, because we have never needed this extra care more. The hospital set aside a separated department for the exhausted workers, the “Hotel Uzsoki”. We will be able to rest there, if after some tiring shift, or between shifts we cannot go home.

The morning passed without me even noticing. I quickly numbed my stomach pain with a sandwich and packed up for the night shift still before the afternoon press conference. My pulse is once again between 90 and 100. I can feel the adrenalin flushing me. I was mad at myself for being so weak.

90531754_1059081767790876_3586912271915286528_n

I listened to the most important information from the press conference, then checked my watch. It was 16:30. The award gala that I waited so, that I was so excited about would have had started half an hour ago. I put on the dress I bought for the gala and my high heeled shoes, in which I practiced to walk resembling a woman. I dressed up pretty, yes. I deserved those quick 5 minutes in my beautiful dress and shoes. I wiped away some tears, but then pulled myself together and rode to the night shift.

03.21.2020.

It’s not panic, It’s fear

After six hours of sleep I woke up still tired. I didn’t feel like eating, so I turned on the computer trusting in the power of the morning coffee. I saw all the emails and messages on my phone, but couldn’t get myself to open them. The ringing of my phone makes me sick now. It’s a pushy little bastard. I pulled myself together and opened the inbox. I got about 70 emails, and found lots of followers of my page. The diary too. Perhaps it’s not useless to write.

Before opening my private emails, I felt a bit nervous. There is such an amount of emails coming every day, it makes me numb. I spend hours by the computer, memorising the most important recommendations that keep pouring on me sometimes in Hungarian, sometimes in English. I would like to do my best, so I read them all. Some of them are easier, caring letters. The management try to keep up the spirit, because they know that the past 2 weeks broke us all. And it all has not even begun yet…

I chatted with the first guests of the ”Hotel Uzsoki”. It feels great that our second home now actually becomes our second home. I might need it at some point as well. I wish I didn’t have these stupid thoughts. I wish this whole ordeal was already over.

I watched the press conference at 3 pm, but did not open any news sites. I just couldn’t. I’m literally sick of all the clickbait “let’s be angry together” type of news. If there is such a need for a common enemy, then why couldn’t this bloody virus be it?

I started getting ready and checked my schedule. I’ll work with a fine little team today. When I got ready, I took a deep breath and checked the news sites. I still had 20 minutes. I shouldn’t have…

There were almost 800 dead in Italy. It devastated me. I read the article frozen, and felt how I lost the track. It’ just not something I can comprehend. I looked at the unknown colleagues in the pictures, thinking that nobody deserves this. I’m scared. I’m worried about my family, my parents, my sister, and her little ones. I’m worried about myself, my colleagues and my sanity. I don’t know how I could endure a Bergamot-like situation here.

 

I rode my bike to work, and could feel how much cooler the weather has become. The cold didn’t bother me, it was rather refreshing. I called my parents and my sister. It was good to hear them. I talked to mum about cooking, then, with dad, we calculated mathematical probabilities. My sister and her family are also fine. It was good to hear the childrens’ noise from the background, it sounded like life itself.

But at work everything is different.

There, we endure the stress better. I cannot explain this. Perhaps it’s that we don’t have to explain our fears, as we all share this difficulty equally. When I got in, I heard that the director got us dinner. We got an astonishing quantity of pizza delivered. I hadn’t eaten all day. I took over the department, designated the tasks and put on the protective gear. I like them all. Although I look like a diving frog in the goggle-mask combo, I don’t care. Finally we stopped wearing our pretty blue gloves, instead, we got an undefined shade of blue that matches our paper gowns. The pizza was delicious, we got fresh bread with it. We ate until we became incapable to move. We laughed a lot. Finally the tension eased a little bit. A few patients came, but it’s not the real rush yet. It’s not that day yet…

03.22. 2020.

Some new colleagues came to visit today. Real experienced ER foxes. We were very happy about it. They work with quick, unhesitating moves and are super motivated. Of course, as they have lived in this for decades.

The department is relatively quiet. This pre-tsunami silence is still damned annoying. There are almost exclusively drunken hobos who drank themselves unconscious and found themselves passed out in the cool spring night. Early in the morning, a few people came, but no crowd. I stayed a bit to talk to the morning shift, listened to everybody’s stories and ate a pancake with nutella. I am a HUGE nutella pancake fan. This was the best breakfast in the past 2 weeks.

Now I woke up after 4 hours of sleep. I looked at today’s numbers and tried to explain the present situation to myself. People aren’t afraid, and they don’t understand why we are. Some elderly ladies and men called the department previously for a little bit of conversation and support, but I feel that many, and especially my generation, do not understand us. Perhaps they find that the numbers aren’t all that scary, and the panic is too big. Perhaps they don’t understand that what’s 130 today, can be 300 tomorrow, and 900 in 3 days. I’m a bit tired and I’m waiting for the night, it would be wonderful to sleep a whole eight hours like I used to, before..